Traditional food consumption and nutritional status of Dalit mothers in rural Andhra Pradesh, South India.

OBJECTIVES: To describe prevalence of malnutrition and their correlates of nutrient and traditional food consumption in rural Dalit mothers. DESIGN: In a cross-sectional study, we used socio-cultural questionnaires, anthropometric measurements and clinical eye examinations during the rainy season in 2003. Food frequency questionnaires and 24-h recalls were conducted during both summer and rainy seasons. SETTING: Dalit mothers with young children were recruited from 37 villages in the Medak District of rural Andhra Pradesh, India. SUBJECTS: Dalit mothers (n = 220) participated. RESULTS: The prevalence of chronic energy-deficient (CED) mothers (body mass index <18.5 kg/m2) was 58%. Illiterate women and active women were more likely to have CED than those literate and non-active (relative risks (RR) = 1.6 and 1.4, respectively, P < or = 0.05), but literacy and activity level were not significant in multivariable analyses including sanitation and number of children < or =5 years of age. Increasing levels of fat intake, as a percent of total energy, was significantly associated with lower risk of CED (RR of the lowest 25th percentile compared to those in the 75th percentile or above was 1.6, P < or = 0.05), findings that remained significant in multivariable analyses. Consumption of pulses (g/day) was also inversely related to CED in univariate and multivariable analyses. Carbohydrate intake, as a percent of total energy, was inversely related to percent energy from fat (r = -0.96, P < or = 0.01), and, although positively related to CED in univariate analyses, carbohydrate consumption was not significant in multivariable analyses. Mothers' age in years and income was positively related to vitamin A deficiency. CONCLUSIONS: These results confirm that CED and vitamin A malnutrition among Dalit women are predominant problems in this area. Increased consumption of local traditional Dalit food (particularly sorghum, pulses, vegetables and animal source food) should be incorporated as an important component of intervention strategies to improve nutritional status.

Human health implications of environmental contaminants in Arctic Canada: A review.

The objectives of this paper are to: assess the impact of exposure to current levels of environmental contaminants in the Canadian Arctic on human health; identify the data and knowledge gaps that need to be filled by future human health research and monitoring; examine how these issues have changed since our first assessment [Van Oostdam, J., Gilman, A., Dewailly, E., Usher, P., Wheatley, B., Kuhnlein, H. et al., 1999. Human health implications of environmental contaminants in Arctic Canada: a review. Sci Total Environ 230, 1-82]. The primary exposure pathway for contaminants for various organochlorines (OCs) and toxic metals is through the traditional northern diet. Exposures tend to be higher in the eastern than the western Canadian Arctic. In recent dietary surveys among five Inuit regions, mean intakes by 20- to 40-year-old adults in Baffin, Kivalliq and Inuvialuit communities exceeded the provisional tolerable daily intakes (pTDIs) for the OCs, chlordane and toxaphene. The most recent findings in NWT and Nunavut indicate that almost half of the blood samples from Inuit mothers exceeded the level of concern value of 5 microg/L for PCBs, but none exceeded the action level of 100 microg/L. For Dene/Métis and Caucasians of the Northwest Territories exposure to OCs are mostly below this level of concern. Based on the exceedances of the pTDI and of various blood guidelines, mercury and to a lesser extent lead (from the use of lead shot in hunting game) are also concerns among Arctic peoples. The developing foetus is likely to be more sensitive to the effects of OCs and metals than adults, and is the age groups of greatest risk in the Arctic. Studies of infant development in Nunavik have linked deficits in immune function, an increase in childhood respiratory infections and birth weight to prenatal exposure to OCs. Balancing the risks and benefits of a diet of country foods is very difficult. The nutritional benefits of country food and its contribution to the total diet are substantial. Country food contributes significantly more protein, iron and zinc to the diets of consumers than southern/market foods. The increase in obesity, diabetes and cardiovascular disease has been linked to a shift away from a country food diet and a less active lifestyle. These foods are an integral component of good health among Aboriginal peoples. The social, cultural, spiritual, nutritional and economic benefits of these foods must be considered in concert with the risks of exposure to environmental contaminants through their exposure. Consequently, the contamination of country food raises problems which go far beyond the usual confines of public health and cannot be resolved simply by risk-based health advisories or food substitutions alone. All decisions should involve the community and consider many aspects of socio-cultural stability to arrive at a decision that will be the most protective and least detrimental to the communities.

Minerals in human teeth: differences between preindustrial and contemporary Hopi Indians.

Mineral elements in dentin from 17th century Hopis were compared with samples from contemporary Hopis living in the same geographic area. Less lead, zinc, and copper, and more strontium were found in the preindustrial teeth. Trace element levels in the contemporary Hopi teeth were similar to those in suburban Californian teeth.

Evaluation of the population distribution of dietary contaminant exposure in an Arctic population using Monte Carlo statistics.

Organochlorines and heavy metals have bioaccumulated in Arctic wildlife, which is an important food source for the Inuit. In this study, we have developed a statistical model to describe the population distribution of contaminant exposure and the usual intake of the high-end contaminant consumers. Monte Carlo methods are used to account for variations due to seasonal dietary pattern and contaminant concentrations. Distribution of the dietary intake of the contaminants of most concern-mercury, polychlorinated biphenyls (PCBs), chlordane, and toxaphenes-are described. Over 50% of the residents had dietary exposure levels exceeding the tolerable daily intake or provisional tolerable daily intake for Hg, toxaphene, and chlordane (83, 91, and 71% for men and 73, 85, and 56% for women, respectively). The high-end consumers (i.e. the 95th centile) have intake levels 6 times higher than the provisional tolerable weekly intake of Hg, and over 20 times the tolerable daily intake of chlordane and toxaphene. Assessment of health risks of the relative high contaminant exposure in this community must also consider the nutritional, economical, cultural, and social importance of these traditional foods. A comprehensive risk management scheme has yet to be developed.

Assessment of dietary exposure to trace metals in Baffin Inuit food.

Chronic metal toxicity is a concern in the Canadian Arctic because of the findings of high metal levels in wildlife animals and the fact that traditional food constitutes a major component of the diet of indigenous peoples. We examined exposure to trace metals through traditional food resources for Inuit living in the community of Qikiqtarjuaq on Baffin Island in the eastern Arctic. Mercury, cadmium, and lead were determined in local food resources as normally prepared and eaten. Elevated concentrations of mercury ( > 50 micrograms/100 g) were found in ringed seal liver, narwhal mattak, beluga meat, and beluga mattak, and relatively high concentrations of cadmium and lead ( > 100 micrograms/100 g) were found in ringed seal liver, mussels, and kelp. Quantified dietary recalls taken seasonally reflected normal consumption patterns of these food resources by adult men and women ( > 20 years old) and children (3-12 years old). Based on traditional food consumption, the average daily intake levels of total mercury for both adults (65 micrograms for women and 97 micrograms for men) and children (38 micrograms) were higher than the Canadian average value (16 micrograms). The average weekly intake of mercury for all age groups exceeded the intake guidelines (5.0 micrograms/kg/day) established by the Joint Food and Agriculture Organization/World Health Organization Expert Committee on Food Additives and Contaminants. The primary foods that contributed to metal intake for the Baffin Inuit were ringed seal meat, caribou meat, and kelp. We review the superior nutritional benefits and potential health risks of traditional food items and implications for monitoring metal contents of food, clinical symptoms, and food use.

Dietary nutrient profiles of Canadian Baffin Island Inuit differ by food source, season, and age.

OBJECTIVE: To compare the effect of food source (traditional or market), season (six seasons), and age (five age groups) on dietary nutrient patterns of Inuit living in Baffin Island, Canada. DESIGN: Twenty-four-hour recall interviews of all residents who had lived > or = 3 years in this one community in each of six seasons. Foods that were recalled were divided by source. SETTING/SUBJECTS: The study took place in the Inuit community of Qikiqtarjuaq, which harvests the highest quantity of wildlife per capita of all Baffin communities. Three hundred sixty-six residents contributed a total of 1,410 recalls: 401 from nonpregnant, nonlactating adult women, 74 from pregnant women, 301 from adult men, 451 from children aged 3 to 12 years, and 183 from teenagers aged 13 to 19 years. Participation was voluntary and averaged 65% to 75% of residents. MAIN OUTCOME MEASURES: Energy, total dry weight of food, and dietary nutrients (ie, carbohydrate, protein, total fat, saturated fat, polyunsaturated fat, vitamin A, iron, copper, zinc, calcium, phosphorus, magnesium, and sodium) were measured by food source, season, and age. Nutrient density (nutrient per 1,000 kcal) was calculated in traditional and market food sources. Selected nutrients were computed in total diets, and compared with Recommended Dietary Allowances (RDAs). STATISTICAL ANALYSES PERFORMED: Tests for normality of the distribution of nutrient intakes (ie, Shapiro-Wilk statistic) were performed followed by nonparametric analyses (ie, Wilcoxon paired-sample t test, Kruskal-Wallis analysis of variance, and adjustment for Bonferroni inequalities resulting from multiple comparisons). RESULTS: Most nutrient intakes were significantly different by food source (P < .05). Traditional food contributed more protein, phosphorus, iron, zinc, copper, magnesium, and vitamin A for several age groups. Market food contributed greater amounts of dry weight, energy, fat, carbohydrate, calcium, and sodium for most age groups. Seasonal variation (P < .05) existed for nutrients coming from traditional and market food. Of the 10 nutrients assessed for nutrient density, all except calcium and sodium were present in greater amounts in traditional food than in market food (P < .05). Calcium and vitamin A intakes fell below 66.6% of the RDAs for more than 60% of the population. CONCLUSIONS: The comprehensive view of nutrient profiles, food source, and seasonality of Inuit diets will assist health professionals in developing nutrition promotion and education programs for all age groups of this population. Traditional food is an essential source of the total annual dietary nutrient intake of Inuit. Results indicated, however, that calcium and vitamin A intake must be improved.

Composition of traditional Hopi foods.

Foods produced by the modern Hopi Indians and prepared in traditional ways are generally good sources of essential minerals, especially if plant ash or native crude salt are added in preparation. The predominant whole grain, mature maize-corn products are relatively high in phytate, which may interfere with absorption of some of the minerals present. The use of culinary ash may have played a critical role in maintenance of nutritional health in the presence of interfering substances in the diet, especially if animal foods were in limited supply.

Dietary intake and body mass index of adults in 2 Ojibwe communities.

OBJECTIVE: To describe and compare dietary intake and prevalence of overweight in a sample of adults in 2 Ojibwe communities in Mille Lacs, Minn, and Lac Courte Oreilles, Wis. DESIGN: Cross-sectional survey based on interviews that included a 24-hour recall, food frequency questionnaire, and a sociocultural questionnaire. SUBJECTS/SETTING: One hundred four adult Band (tribe) members were selected randomly from current housing lists; pregnant and lactating women were excluded. STATISTICAL ANALYSES PERFORMED: Nonparametric Wilcoxon rank sum tests were used to determine differences in absolute nutrient intakes where normality could not be assumed. Two-tailed t tests were conducted to test for differences between nutrient densities. A significance level of alpha = .05 was used; procedurewise adjustments were made using the Bonferroni method when adjusting for multiple comparisons. RESULTS: The importance of the traditional food system was evident: at least 50% of respondents engaged in hunting and fishing practices. Prevalence of overweight was 47%. Mean nutrient intakes were below the Recommended Dietary Allowance for women for vitamin A, folate, calcium, iron, and zinc and for men for vitamin A and calcium, despite energy intakes that met the Recommended Dietary Allowance. Nutrient densities were lower than those in the third National Health and Nutrition Examination Survey for women for carbohydrate, vitamin C, folate, calcium, and dietary fiber and for men for folate and dietary fiber. Fat contributed 37% (for men) and 40% (for women) of energy intake. APPLICATIONS/CONCLUSIONS: Areas of focus for culturally relevant education programs (eg, promotion of traditional foods that provide nutrients of low intake status and low-fat traditional food preparation methods) and research needs are suggested to reduce risks for nutrition-related chronic disease among Native Americans.

Mutagens in feces from vegetarians and non-vegetarians.

Mutagens in water extracts from feces of persons in 3 different diet groups were measured with the fluctuation test for weak mutagens using Salmonella typhimurium TA100 and TA98 as tester strains. The 3 diet groups were ovo-lacto vegetarians (N = 6), strict vegetarians (N = 11) and non-vegetarians (N = 12). All subjects were from the urban area of Vancouver, British Columbia, Canada. On TA100 ovo-lacto vegetarians and strict vegetarians had significantly lower levels of fecal mutagens than non-vegetarians (P less than or equal to 0.025 and P less than 0.010, resp.). The same pattern, although less significant, was obtained with TA98. Correlation studies between mutagenicity on TA100 and TA98 and between the pH of the fecal homogenate and mutagenicity indicate the presence of 2 or more major fecal mutagens.

The effect of short-term dietary modification on human fecal mutagenic activity.

To assess the effect of short-term modification of diet on human fecal mutagenic activity, 6 subjects consumed 2 dietary regimes hypothesized to affect risk of colorectal cancer. After a 7-day baseline period, a 'low-risk' non-meat diet was consumed for 2 weeks followed by 2 weeks on a 'higher risk' diet which emphasized beef and refined grains. Fecal samples were collected at the end of each diet period and assayed for direct-acting mutagens with the fluctuation test for weak mutagens using Salmonella typhimurium TA100 and TA98 as tester strains. Fecal mutagenic activity on TA100 was increased for all subjects during the 'higher risk' period compared to the 'low risk' period. The average mutagenicity on TA98 was also increased, but the trend was not consistent for all subjects. The baseline diet and non-meat diet resulted in approximately equal mean fecal mutagenicity levels. These findings indicate that a diet high in meat and refined grain, as characterized here, increases fecal mutagenic activity within a 2-week period.

Population exposure to radioactivity from consumption of caribou among the Dene/Métis of Denendeh (western Northwest Territories, Canada).

There has been long-standing concern with exposure to radioactivity through the consumption of caribou, particularly in indigenous populations in the western Northwest Territories, Canada, who are traditionally high consumers. We conducted a dietary survey in this region in 1994 to estimate population exposure levels. Dietary information was collected from 1012 individuals in sixteen communities (1012 days of 24-hour dietary recalls, 1012 food frequency questionnaires) and radionuclide levels in caribou flesh, liver and kidneys were measured. Monte Carlo statistical methods were employed to integrate these data sets and estimate the distribution of radiation exposure for people in five regions (Gwich'in, Sahtú, Dogrib, Deh-Cho, South Slave). The exposure levels were highest in the South Slave region and in older males (40+ years), and lowest in the Gwich'in region and in younger females (20-40 years). Median exposure level ranged from 0.95 to 5.31 mSv per year (mean of medians = 2.96 mSv/y). In each group the 95th percentile of exposure was 2-3 times greater than the median. These exposure levels are comparable to exposure levels in Alaskan Eskimos and Marshall Island residents, and are much higher than European or American urban populations. Caribou meat is a very nutritious food. We conclude that, although there is some radiation exposure from consuming caribou, the associated health risks are low and are outweighed by the physical, social and cultural benefits derived from hunting and eating caribou.

Long-chain n-3 fatty acids in breast milk of Inuit women consuming traditional foods.

The fatty acid composition of mature breast milk total lipids was analysed in milk from Inuit women living in a small Arctic community. Long-chain n-3 fatty acids were higher than in comparable samples from Vancouver residents. The data suggest that secretion of n-3 fatty acids in milk is influenced by the dietary intake of the lactating woman. The levels of these fatty acids in Inuit milk approximate those reported for the diet fat of adult Eskimo, and which have been associated with reduced plasma cholesterol levels and death from coronary heart disease.

The composition of red cell membrane phospholipids in Canadian Inuit consuming a diet high in marine mammals.

A study of the fatty acid composition of red cell phosphatidylcholine and phosphatidylethanolamine and serum cholesterol was undertaken in 185 Canadian Inuit (age 2 months-82 years). Samples from 24 Canadian men and women (21-50 years) living in Vancouver were also analyzed as a reference for the Inuit in this age range. Dietary survey of the Inuit community (325 Inuit) demonstrated a diet based on traditional foods in which the principal source of n-3 fatty acid was marine mammal flesh (mean intake: 164 g/person/day) rather than fish (mean intake: 13 g/person/day). Compared to the Vancouver samples, the Inuit phosphatidylethanolamine had higher 20:5n-3 and 22:6n-3 and lower 20:4n-6, but similar 18:2n-6 levels. The level of 20:5n-3 was higher and 20:4n-6 was lower in the Inuit than in the Vancouver red cell phosphatidylcholine. Despite these differences in percentage content of C20 and C22 n-6 and n-3 fatty acids, the mean chain length and unsaturation index of the Inuit and Vancouver red cell phosphatidylcholine and phosphatidylethanolamine were very similar. Serum cholesterol concentration showed no sex difference within the Inuit, and no difference from Vancouver men and women of similar age. The analyses suggest that the fatty acid composition of the Inuit red cell phospholipids are primarily a reflection of their diet-fat composition.

Inuit foods and diet: a preliminary assessment of benefits and risks.

Traditional Inuit foods are contaminated with chemical residues from industrial and other activities around the world. The intake of polychlorinated biphenyls (PCBs) and polychlorinated camphenes (PCCs) exceeds the 'tolerable daily intake' (TDI) for many consumers. The implications of long term contaminant intake, even for single contaminants, are not known and will be difficult or impossible to determine in the foreseeable future. Traditional foods form a substantial part of the Inuit diet and are a major source of energy and essential nutrients. Available alternative imported foods are nutritionally inferior and substitution may lead to nutritional deficiencies and associated risks to health and to the social and cultural life of Arctic communities.

Human health implications of environmental contaminants in Arctic Canada: a review.

This paper assesses the impact on human health of exposure to current levels of environmental contaminants in the Canadian Arctic, and identifies the data gaps that need to be filled by future human health research and monitoring. The concept of health in indigenous groups of the Arctic includes social, cultural, and spiritual dimensions. The harvesting, sharing and consumption of traditional foods are an integral component to good health among Aboriginal people influencing both physical health and social well-being. Traditional foods are also an economic necessity in many communities. Consequently, the contamination of country food raises problems which go far beyond the usual confines of public health and cannot be resolved by health advisories or food substitutions alone. The primary exposure pathway for the contaminants considered in this paper is through the traditional northern diet. For the Inuit, the OCs of primary concern at this time from the point of view of exposure are chlordane, toxaphene, and PCBs. Exposures are higher in the eastern than in the western region of the North. For Dene/Metis, exposure to OCs is in general below a level of concern. However, estimated intake of chlordane and toxaphene has been found to be elevated for certain groups and is a cause for concern if exposures are elevated on a regular basis. The developing foetus and breast-fed infant are likely to be more sensitive to the effects of OCs and metals than individual adults and are the age groups at greatest risk in the Arctic. Extensive sampling of human tissues in the Canadian north indicate that a significant proportion of Dene, Cree and Inuit had mean maternal hair mercury levels within the 5% risk-range proposed by the WHO for neonatal neurological damage. Based on current levels, lead does not appear to pose a health threat while cadmium is likely only a major risk factor for heavy smokers or consumers of large amounts of organ meats. Consumers of traditional foods are exposed to an approximately seven-fold higher radiation dose than non-consumers of traditional foods due predominantly to the bioaccumulation of natural radionuclides in the food chain. Risk determination for contaminants in country food involves a consideration of the type and amounts of food consumed and the sociocultural, nutritional, economic, and spiritual benefits associated with country foods. Risk management options that minimize the extent to which nutritional and sociocultural aspects of Aboriginal societies are compromised must always be considered.

Ooligan grease: a traditional food fat of western Canada and Alaska.

First Nations Peoples prepare ooligan grease by ripening several tons of the small fish, Thaleichthys pacificus, and rendering the fish oil. Eighteen samples from different family preparations of five cultural areas were analyzed for a spectrum of nutrients, organochlorines, and heavy metals. Ooligan grease was found to be a rich source of retinol (2444 +/- 1198 RE/100 g) and n-3 fatty acids, but had less vitamin A compared to fat of raw fish. There was a 10-fold increase in n-3 fatty acids in grease compared to raw fish fat, which may be attributed to microbial conversion of other fatty acids to DHA. Whole fish were good sources of Ca, Fe, and Zn; heavy metals were below guideline levels in grease. Chlorinated pesticides and PCB increased from north to south locations in British Columbia, with mean levels being 110 ng/g lipid of total chlorinated pesticides and 30 ng/g lipid of PCB. These levels are below regulation limits established by Health Canada. It is concluded that ooligan grease is a superior food fat and safe for human consumption.

Sources of bias in estimates of calcium and vitamin A intakes of indigenous peoples in the Northwest Territories, Canada.

Calcium and vitamin A have consistently been reported as nutrients at risk among northern indigenous peoples in Canada. Using a data set recently collected in the Sahtú region of Denendeh, Northwest Territories, potential sources of bias and their effect on estimates of dietary intake are investigated. Calcium and vitamin A intakes appear to be underestimated to differing extents and for differing reasons specific to each nutrient. Underestimation of calcium intake may affect a large portion of the dietary records and is most likely due to insufficient probing for methods of food preparation during dietary interviews. Underestimation of vitamin A intake appears to affect a smaller proportion of the food records and be related to the difficulty of recording the occurrence of rare and seasonal events. In both cases, more precise nutrient composition data are needed to reflect nutrient content of traditional food as consumed.

Benefits of traditional food in Dene/Métis communities.

Data collected in 16 Dene/Métis communities are used to illustrate the many nutritional, economic, and sociocultural benefits associated with the harvest and consumption of traditional food by indigenous peoples. These include exceptional nutrient composition, absence of industrial processing that changes quality and taste properties, taste preference, reasonable cost compared to market food, quality of the time spent on the land, increased physical activity, sharing of the harvest within the community, opportunity to practice spirituality, and encouragement for children to discover the natural environment. The importance of traditional food to the health of individuals and communities can be directly related to the nutritional value of the food itself, the physical activity associated with its procurement, and its role in mediating positive health determinants such as self-efficacy and locus of control.

Traditional food systems research with Canadian Indigenous Peoples.

Traditional food systems research with Canadian Indigenous Peoples has revealed many aspects of benefits and risks of the use of this food. Traditions based in hunting, fishing and gathering contain a great variety of species of wildlife plants and animals that provide rich cultural and nutritional benefits. Dietary change for Indigenous Peoples in Canada has resulted in the use of traditional food to provide usually less than 30% of total dietary energy; however this portion of the total diet contributes significantly more of essential nutrients. It also results in exposure to organochlorine and heavy metal contaminants that exceed the tolerable intake levels for some areas. A successful research and education intervention program with one British Columbia community demonstrated that increasing traditional food use can improve health status for vitamin A, iron and folic acid. It is concluded that traditional food systems are rich with potential for research and public health education intervention programs for Indigenous Peoples.

Preparation effects on tortilla mineral content in Guatemala.

We have previously reported that in Guatemala, the calcium, iron, and zinc contents of tortillas from rural areas are higher that that of tortillas from urban centers. This study examines variation in the calcium, iron, zinc and copper content of tortilla according to the implements used for making tortillas and inquires as to whether preparation effects mediate rural-urban variation in tortilla mineral content. Tortilla samples and information on how the tortillas were prepared were collected from the female heads of a total of 50 households from three rural, two semi-urban and one low income urban community. Samples of lime used for making tortillas were collected from 31 households. To grind masa, a hand mill was found to be used in some rural households whereas a motorized mill predominated in the semi-urban and urban areas. Most women used grinding stones called the "mano y metate" to further refine the texture of the masa. Tortillas prepared with the combined use of the hand mill and "mano y metate" had a significantly (p < 0.05) higher iron content. Use of the "mano y metate" was also associated with a significantly (p < 0.05) higher zinc content. These results suggest that the use of certain grinding implements may mediate rural-urban variation in tortilla iron and zinc content. The cooking surface, pot used for nixtamalization, source of water, and amount of lime used did not significantly account for variation in the content of these minerals.